HIV/AIDS & Socioeconomic Status
Socioeconomic status (SES) is often measured as a combination of education, income and occupation. It is commonly conceptualized as the social standing or class of an individual or group. When viewed through a social class lens, privilege, power and control are emphasized. Furthermore, an examination of SES as a gradient or continuous variable reveals inequities in access to and distribution of resources. SES is relevant to all realms of behavioral and social science, including research, practice, education and advocacy.
SES Affects Everyone
Variance in socioeconomic status, including disparities in the distribution of wealth, income and access to resources, affects everyone. Inequities in wealth and quality of life are increasing in the United States and globally. Behavioral and other social science professionals possess the tools necessary to study and identify strategies that could alleviate these disparities at both individual and societal levels. Low SES and its correlates, such as lower education, poverty and poor health, ultimately affect our society as a whole. Everyone benefits from an increased focus on the foundations of socioeconomic inequities and efforts to reduce the deep gaps in socioeconomic status in the United States and abroad.
SES Impacts the Lives of People With HIV/AIDS
Domestically and internationally, HIV is a disease that is embedded in social and economic inequity (Perry, 1998), as it affects those of lower socioeconomic status at a disproportionately high rate. Research on SES and HIV/AIDS suggests that a person’s socioeconomic standing may affect his or her likelihood of contracting HIV and developing AIDS. Furthermore, SES is a key factor in determining the quality of life for individuals after they are affected by the virus. Those with fewer resources are often left with limited treatment options.
SES Affects HIV Infection
A lack of socioeconomic resources is linked to the practice of riskier health behaviors, which can lead to the contraction of HIV. These behaviors include earlier initiation of sexual activity and less frequent use of condoms (Adler, 2006).
Among women, lower social standing and the experience of life stress are associated with riskier sexual practices. This finding suggests that while ethnicity is a critical factor in the HIV/AIDS epidemic for women, social class is also an important risk factor in HIV infection (Ickovics et al., 2002).
Unstable housing has been linked to risk for HIV infection, including IV drug use and unsafe sexual behaviors (Aidala, Cross, Stall, Harre, & Sumartojo, 2005). Individuals who are homeless or in unstable housing arrangements are significantly more likely to be infected with HIV compared to individuals in more stable housing environments (Culhane, Gollub, Kuhn, & Shpaner, 2001).
Lack of socioeconomic resources is also associated with risk factors for neuropsychiatric dysfunction, such as exposure to environmental toxins and injuries. These factors can make persons with HIV more vulnerable to the central nervous system effects of the virus, including more rapid cognitive decline and onset of dementia (Satz, 1993).
HIV Status Affects SES
HIV status often has a negative impact on socioeconomic status by constraining an individual’s ability to work and earn income.
Research indicates that up to 45 percent of people living with HIV are unemployed (Rabkin, McElhiney, Ferrando, Van Gorp, & Lin, 2004).
The effects of HIV on physical and mental functioning can make maintaining regular employment difficult. Patients with HIV infection may also find that their work responsibilities compete with their health care needs. Individuals infected with HIV are often discriminated against in the workplace, leading to their termination or forced resignation (Dray-Spira, Lert, Marimoutou, Bouhnik, & Obadia, 2003; Kass et al., 1994).
Children infected with HIV often exhibit cognitive deficits when compared with their uninfected peers (Martin et al., 2006). These deficits can adversely affect learning and earning ability later in life.
SES Affects HIV Treatment
SES status often determines access to HIV treatment. Individuals of low SES have delayed treatment initiation relative to more affluent patients, reducing their chances of survival (Joy et al., 2008).
Patients of lower SES with HIV have increased morbidity and mortality rates. Research suggests a correlation between low SES and earlier death from HIV/AIDS (Cunningham et al., 2005). Accordingly, individuals of higher SES levels experience slower progression of HIV infection (Schechter et al., 1994).
Decreased access to health insurance and preventive services is a major contributor to health disparities between high- and low-SES individuals. Low-income individuals are not likely to have health coverage or receive optimal treatment and care for HIV/AIDS, such as Highly Active Antiretroviral Therapy (HAART) (Wood et al., 2002).
What You Can Do
Include SES in your research, practice and educational endeavors
Consider measuring, reporting and controlling for SES in all research and published work on older adults. Report participant characteristics related to SES.
Contribute to the body of research on the societal barriers experienced by people with HIV and AIDS, particularly low SES group and/or persons of minority status, and the impact of these barriers on health and positive well-being.
Consider how SES affects clients’ presenting problems, ways of coping and the development of effective treatment strategies.
Ensure that trainees are sensitive to age and the implications of aging on the psychological and physical health of clients. Provide trainees with experience with clients who are living with HIV/AIDS.
Combat discrimination against people with HIV and AIDS in your workplace and advocate for equal access to resources that promote healthy behaviors
Support legislation and policies that explore and work to eliminate socioeconomic disparities. Visit the Office on Government Relations for more details.
Become an SES Key Contact! As an expert, advocate for SES-related issues.
Join APA’s SES Network to contribute to and stay abreast of current developments in SES-related activities
Visit APA’s Office on Socioeconomic Status (OSES) website.
Visit APA’s Office on AIDS website.
References can be found online.